Radiology Commons^™

Commentary: Through Thick And Thin, Jonathan C Hong, Joseph S Coselli

Faculty, Staff and Students Publications

No abstract provided.

Anatomy Versus Physiology: Is Breast Lymphatic Drainage To The Internal Thoracic (Internal Mammary) Lymphatic System Clinically Relevant?, Priscilla Machado, Ji-Bin Liu, Laurence Needleman, Christine Lee, Flemming Forsberg

Department of Radiology Faculty Papers

Approximately 15%−25% of breast lymphatic drainage passes through the internal thoracic (internal mammary) lymphatic system, draining the inner quadrants of the breast. This study aimed to use lymphosonography to identify sentinel lymph nodes (SLNs) in the axillary and internal thoracic lymphatic systems in patients with breast cancer. Seventy-nine patients received subcutaneous ultrasound contrast agent injections around the tumor. Lymphosonography was used to identify SLNs. In 14 of the 79 patients (17.7%), the tumor was located in the inner quadrant of the breast. Lymphosonography identified 217 SLNs in 79 patients, averaging 2.7 SLNs per patient. The 217 identified SLNs in the …

Microwave Ablation As A Primary Versus Secondary Treatment For Hepatocellular Carcinoma., Philip Lee, Ajay Makkena, Mohamed Tantawi, Felipe Velasquez-Botero, John R. Eisenbrey, Colette M. Shaw

Department of Radiology Faculty Papers

PURPOSE: The purpose of this study was to analyze and compare the outcomes of percutaneous microwave ablation (MWA) when used as a primary vs. secondary treatment for hepatocellular carcinoma (HCC).

METHODS: The clinical data of 192 patients with HCC treated with MWA between January 2012 and July 2021 were reviewed retrospectively, with 152 patients being treatment naïve (primary treatment) vs. 40 who had residual or recurrent disease following previous trans-arterial chemoembolization or trans-arterial radioembolization (secondary treatment). The primary outcomes were primary technical efficacy, 1- and 3-year local recurrence-free survival (RFS) and overall survival (OS), local recurrence rates, and adverse events. …

Differentiating Axonal From Demyelinating Neuropathies Using Multiparametric Quantitative Mri Of Peripheral Nerves, Jacob D. Baraz, Stephanie Xuan, Sadaf Saba, Xue Yang, Ryan Castoro, Yang Xuan, Alison Roth, Richard D. Dortch, Jun Li, Yongsheng Chen

Medical Student Research Symposium

Objectives: To develop a multiparametric quantitative MRI (qMRI) method to track pathological changes in the peripheral neuropathies.

Background: Irrespective of the causes or types of polyneuropathies, peripheral nerves are mainly afflicted by two kinds of pathologies – axonal loss and demyelination. It is critical to differentiate between the two as treatments are different for the two conditions. While nerve conduction studies (NCS) have been used to differentiate the two pathologies in the distal nerves, there are no tools to probe the pathologies in the proximal peripheral nerves. This is particularly needed when distal nerves become non-responsive in NCS.

Methods: We …

The Effect Of A Magnetic Resonance Imaging Sedation Protocol On Increasing Sedation Related Adverse Event Reporting Frequency And Anesthesia Utilization In The Henry Ford Health System, Bohdan Matsko, Mousab Eteer Md, Khalid Eteer Md, Muhammad Ibrahim Md

Medical Student Research Symposium

INTRODUCTION: Procedural sedation is intended to help patients minimize body movement and successfully complete an MRI scan. Although MRI sedation is becoming increasingly more common, it is associated with complications. There has been anecdotal evidence of MRI sedation adverse events occurring at relatively high frequency at HFHS in the past, although such events often went unreported. The study aim is to address this rising concern by instituting a protocol system that also intends to increase the reporting of MRI sedation adverse events.

METHODS: This Quality improvement (QI) project is established based on the Lean Six Sigma process improvement methodology. The …

Cognitive Sparing In Proton Versus Photon Radiotherapy For Pediatric Brain Tumor Is Associated With White Matter Integrity: An Exploratory Study, Lisa E Mash, Lisa S Kahalley, Kimberly P Raghubar, Naomi J Goodrich-Hunsaker, Tracy J Abildskov, Luz A De Leon, Marianne Macleod, Heather Stancel, Kelley Parsons, Brian Biekman, Nilesh K Desai, David R Grosshans, Arnold C Paulino, Zili D Chu, William E Whitehead, Mehmet Fatih Okcu, Murali Chintagumpala, Elisabeth A Wilde

Faculty, Staff and Student Publications

Radiotherapy for pediatric brain tumors is associated with reduced white matter structural integrity and neurocognitive decline. Superior cognitive outcomes have been reported following proton radiotherapy (PRT) compared to photon radiotherapy (XRT), presumably due to improved sparing of normal brain tissue. This exploratory study examined the relationship between white matter change and late cognitive effects in pediatric brain tumor survivors treated with XRT versus PRT. Pediatric brain tumor survivors treated with XRT (

Endovascular Image-Guided Sampling Of Tumor-Draining Veins Provides An Enriched Source Of Oncological Biomarkers, Anobel Tamrazi, Srividya Sundaresan, Aishwarya Gulati, Frederick J. Tan, Vibhor Wadhwa, Bjarne R. Bartlett, Luis A. Diaz Jr.

Department of Radiology Faculty Papers

Introduction: Circulating tumor-derived biomarkers can potentially impact cancer management throughout the continuum of care. This small exploratory study aimed to assess the relative levels of such biomarkers in the tumor-draining vascular beds in patients with solid tumors compared to levels in their peripheral veins.

Methods: Using an endovascular image-guided approach, we obtained blood samples from peripheral veins and other vascular compartments–including the most proximal venous drainage from solid tumors–from a set of nine oncology patients with various primary and metastatic malignancies. We then interrogated these samples for a panel of oncological biomarkers, including circulating tumor cells (CTCs), exosome-derived microRNAs (miRNAs), …

Cyanobacteria And Algal-Based Biological Life Support System (Blss) And Planetary Surface Atmospheric Revitalizing Bioreactor Brief Concept Review, Ryan Keller, Karthik Goli, William Porter, Aly Alrabaa, Jeffrey A Jones

Faculty, Staff and Students Publications

Exploring austere environments required a reimagining of resource acquisition and utilization. Cyanobacterial in situ resources utilization (ISRU) and biological life support system (BLSS) bioreactors have been proposed to allow crewed space missions to extend beyond the temporal boundaries that current vehicle mass capacities allow. Many cyanobacteria and other microscopic organisms evolved during a period of Earth's history that was marked by very harsh conditions, requiring robust biochemical systems to ensure survival. Some species work wonderfully in a bioweathering capacity (siderophilic), and others are widely used for their nutritional power (non-siderophilic). Playing to each of their strengths and having them grow …

Safety Of Nivolumab Added To Chemoradiation Therapy Platforms For Intermediate And High-Risk Locoregionally Advanced Head And Neck Squamous Cell Carcinoma: Rtog Foundation 3504, Maura L Gillison, Robert L Ferris, Jonathan Harris, A Dimitrios Colevas, Loren K Mell, Christina Kong, Richard C Jordan, Kevin L Moore, Minh-Tam Truong, Claudia Kirsch, Arnab Chakravarti, Dukagjin M Blakaj, David A Clump, James P Ohr, John F Deeken, Michael F Gensheimer, Nabil F Saba, Jennifer A Dorth, David I Rosenthal, Rom S Leidner, Randall J Kimple, Mitchell Machtay, Walter J Curran, Pedro Torres-Saavedra, Quynh Thu Le

Faculty, Staff and Student Publications

PURPOSE: Programmed death-1 immune checkpoint blockade improves survival of patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC), but the benefits of addition to (chemo)radiation for newly diagnosed patients with HNSCC remain unknown.

METHODS AND MATERIALS: We evaluated the safety of nivolumab concomitant with 70 Gy intensity modulated radiation therapy and weekly cisplatin (arm 1), every 3-week cisplatin (arm 2), cetuximab (arm 3), or alone for platinum-ineligible patients (arm 4) in newly diagnosed intermediate- or high-risk locoregionally advanced HNSCC. Patients received nivolumab from 2 weeks prior to radiation therapy until 3 months post-radiation therapy. The primary endpoint was dose-limiting …

Effective Connectivity Of Functional Mri Via Deep Learning Methods, Kai-Cheng Chuang

LSU Doctoral Dissertations

Effective connectivity, based on functional magnetic resonance imaging (fMRI) time series signals, is the quantification of how strongly brain activity in a certain source brain region contributes to brain activity in a target brain region, independent of the contributions of other source regions. Current methods to solve this problem have several limitations. They are either unable to model nonlinear relationships between source and target signals, unable to efficiently quantify time lags in source-target relationships, unable to identify time-varying relationships, or fail to account for variability in the hemodynamic response function that converts neuron activity to a measurable signal. In this …

A Case Of Congenital Coronary Sinus Ostial Atresia With Persistent Left Superior Vena Cava, Laura Onderko, Thomas A. Miller, Sean Novak, Jeffrey Rosenblatt

Journal of Maine Medical Center

Introduction: The coronary sinus is responsible for venous drainage of the heart. Congenital anomalies of the coronary sinus are rare and typically associated with other anomalies, such as atrial septal defects or other congenital heart malformations.

Clinical Findings: We present a case of incidentally found atresia of the coronary sinus ostium with associated persistent left superior vena cava. This case involved a 52-year-old patient who initially presented with a supraventricular tachycardia and elevated troponin.

Clinical Course: The patient underwent cardiac workup with a coronary computed tomographic angiography scan. This scan showed no obstructive coronary artery disease, but did show congenital …

Utility Of Hand‑Held Ultrasound For Image Acquisition And Interpretation By Trained Kenyan Providers, Grace Wanjiku, Lindsay Dreizler, Shirley Wu, Janette Baird, Benjamin Wachira

Emergency Medicine, East Africa

Background: Point-of-care ultrasound (POCUS) plays a prominent role in the timely recognition and management of multiple medical, surgical, and obstetric conditions. A POCUS training program for primary healthcare providers in rural Kenya was developed in 2013. A significant challenge to this program is the acquisition of reasonably priced ultrasound machines with adequate image quality and the ability to transmit images for remote review. The goal of this study is to compare the utility of a smartphone-connected, hand-held ultrasound with a traditional ultrasound device for image acquisition and interpretation by trained healthcare providers in Kenya.

Methods: This study took place …

Long-Term Safety And Efficacy Of Non-Absorbable Abdominal Mesh For Apical Prolapse Surgery: A 10-Year Experience At Tertiary Care Hospital, Samia Aijaz, Novera G. Chughtai, Urooj Kashif, Summera Malik

Department of Obstetrics & Gynaecology

Objectives: To evaluate the complications of apical prolapse correction with abdominally placed mesh and to assess the long-term efficacy of Sacrohysteropexy and Sacrocolpopexy.
Method: A retrospective cohort study was conducted at the Department of Gynecology and Obstetrics, Aga Khan University Hospital. All women who underwent apical prolapse surgery using abdominal mesh from January 2010 to December 2019 at AKUH were included. Patients with missing routine follow up visits and incomplete data up to one year post op were excluded. Patient notes were reviewed, and subjective and objective success and complications were analyzed. Safety was measured by incidence of intra, early …

An Artificial Neural Network For Nasogastric Tube Position Decision Support, Ignat Drozdov, Rachael Dixon, Benjamin Szubert, Jessica Dunn, Darren Green, Nicola Hall, Arman Shirandami, Sofia Rosas, Ryan Grech, Srikanth Puttagunta, Mark Hall, David J Lowe

Faculty, Staff and Student Publications

PURPOSE: To develop and validate a deep learning model for detection of nasogastric tube (NGT) malposition on chest radiographs and assess model impact as a clinical decision support tool for junior physicians to help determine whether feeding can be safely performed in patients (feed/do not feed).

MATERIALS AND METHODS: A neural network ensemble was pretrained on 1 132 142 retrospectively collected (June 2007-August 2019) frontal chest radiographs and further fine-tuned on 7081 chest radiographs labeled by three radiologists. Clinical relevance was assessed on an independent set of 335 images. Five junior emergency medicine physicians assessed chest radiographs and made feed/do …

Sentinel Lymph Node Identification Using Contrast Lymphosonography: A Systematic Review, Priscilla Machado, Ji-Bin Liu, Flemming Forsberg

Department of Radiology Faculty Papers

The sentinel lymph node (SLN) concept hypothesizes that metastatic cancer cells will spread through the lymphatic system to the SLN being the first one in the lymphatic chain to receive the metastatic cells, indicating that if the SLN is free of cancer cells the rest of the lymphatic chain is also without metastatic disease. Diagnostic ultrasound imaging (US) has been used to evaluate lymph nodes (LN) to determine level of suspicion and to guide LN biopsies. However, conventional US cannot be used for lymphatic mapping, which requires administration of a tracer. This has been changed with the use of contrast-enhanced …

Imaging Features Of Immune Checkpoint Inhibitor-Related Nephritis With Clinical Correlation: A Retrospective Series Of Biopsy-Proven Cases, Muhammad O Awiwi, Ala Abudayyeh, Noha Abdel-Wahab, Adi Diab, Migena Gjoni, Guofan Xu, Raghu Vikram, Khaled Elsayes

Faculty, Staff and Student Publications

OBJECTIVES: Imaging appearances of immune checkpoint inhibitor-related nephritis have not yet been described. The primary objective of this study is to describe the appearances of immunotherapy-related nephritis on computerized tomography (CT) and positron emission tomography (PET). The secondary objectives are to investigate the association of radiologic features with clinical outcomes.

METHODS: CT and PET-CT scans before the initiation of immunotherapy (baseline), at nephritis, and after resolution of pathology-proven nephritis cases were reviewed. Total kidney volume, renal parenchymal SUVmax, renal pelvis SUVmax, and blood pool SUVmean were obtained.

RESULTS: Thirty-four patients were included. The total kidney volume was significantly higher at …

Ninety-Day Mortality Following Transoral Robotic Surgery Or Radiation At Commission On Cancer-Accredited Facilities, James R Janopaul-Naylor, Manali Rupji, Rachel A Tobillo, Joshua W Lorenz, Jeffrey M Switchenko, Sibo Tian, Azeem S Kaka, David C Qian, Ashley J Schlafstein, Conor E Steuer, Jill S Remick, Soumon Rudra, Mark W Mcdonald, Nabil F Saba, William A Stokes, Mihir R Patel, James E Bates

Faculty, Staff and Student Publications

BACKGROUND: Postoperative mortality for oropharynx squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) varies from 0.2% to 6.5% on trials; the real-world rate is unknown.

METHODS: NCDB study from 2010 to 2017 for patients with cT1-2N0-2M0 OPSCC with Charleson-Deyo score 0-1. Ninety-day mortality assessed from start and end of treatment at Commission on Cancer-accredited facilities.

RESULTS: 3639 patients were treated with TORS and 1937 with radiotherapy. TORS cohort had more women and higher income, was younger, more often treated at academic centers, and more likely to have private insurance (all p < 0.05). Ninety-day mortality was 1.3% with TORS and 0.7% or 1.4% from start or end of radiotherapy, respectively. From end of therapy, there was no significant difference on MVA between treatment modality.

CONCLUSIONS: There is minimal difference between 90-day mortality …

Vidutolimod In Combination With Atezolizumab With And Without Radiation Therapy In Patients With Programmed Cell Death Protein 1 Or Programmed Death-Ligand 1 Blockade-Resistant Advanced Nsclc, Marcelo V Negrao, Vassiliki A Papadimitrakopoulou, Andrew C Price, Alda L Tam, Muhammad Furqan, Sandeep T Laroia, Erminia Massarelli, Jose Pacheco, John V Heymach, Anne S Tsao, Gary V Walker, Lalit Vora, David Mauro, Heather Kelley, James E Wooldridge, Arthur M Krieg, Jiaxin Niu

Faculty, Staff and Student Publications

INTRODUCTION: Vidutolimod, a CpG-A TLR9 agonist, was investigated in a phase 1b study (CMP-001-003; ClinicalTrials.gov, NCT03438318) in combination with atezolizumab with and without radiation therapy (RT) in patients with advanced NSCLC.

METHODS: Patients with progressive disease after anti-programmed cell death protein 1 or programmed death-ligand 1 therapy received either vidutolimod and atezolizumab (part A) or vidutolimod, atezolizumab, and RT (part B). The primary objective was to evaluate the safety of vidutolimod and atezolizumab with and without RT. Key secondary end point was best objective response rate per Response Evaluation Criteria in Solid Tumors, version 1.1.

RESULTS: Between March 28, 2018, …

Circulating Neutrophils And Tumor-Associated Myeloid Cells Function As A Powerful Biomarker For Response To Chemoradiation In Locally Advanced Cervical Cancer, Olsi Gjyshi, Adam Grippin, Lauren Andring, Anuja Jhingran, Lilie L Lin, Julianna Bronk, Patricia J Eifel, Melissa M Joyner, Jagannadha K Sastry, Kyoko Yoshida-Court, Travis N Solley, Tatiana Cisneros Napravnik, Madison P O'Hara, Venkatesh L Hegde, Lauren E Colbert, Ann H Klopp

Faculty, Staff and Student Publications

PURPOSE: The immune system's role in mediating the cytotoxic effects of chemoradiotherapy remains not completely understood. The integration of immunotherapies into treatment will require insight into features and timing of the immune microenvironment associated with treatment response. Here, we investigated the role of circulating neutrophils and tumor-associated myeloid cells (TSAMs) as potential agents and biomarkers for disease-related outcomes in locally advanced cervical cancer (LACC).

MATERIAL AND METHODS: Hematologic parameters for two LACC patient cohorts, a retrospective clinical and a prospective translational cohort, were obtained at baseline, weekly during chemoradiotherapy for the retrospective cohort, biweekly during chemoradiotherapy for the prospective cohort, …

Metallic Implant-Related Osteosarcoma, Frawa Mohsin, Mustafa Bin Ali Zubairi, Kulsoom Fatima, Muhammad Asad Diwan

Department of Radiology

Orthopedic metallic prostheses are commonly used in the current practice of orthopedic surgery. Although, biomaterials used in these implants are generally considered to be biologically inert, there have been consequences of foreign body reactions and potential carcinogenesis. Majority of implant-related malignancies are high grade, and develop in bone or soft tissue around the implant site. No clear association has been identified between the biomaterial implanted and the type of sarcoma. We report the case of a 36-year-old male who underwent intramedullary nailing of femur for mid-shaft fracture secondary to trauma and presented with osteogenic sarcoma of femur 14 months later.